The Diagnosis and Management of Recurrent Gallstone Ileus: A Case Report

Abstract

Gallstone ileus is one of the rare and insidious causes of small bowel obstruction, which should always be kept in mind by clinicians, especially when encountering older people with a history of gallstones disease. The high mortality and morbidity rate associated with the condition can be mostly attributed to delayed or misdiagnosis. Imaging modalities, particularly CT scans, play an important role in correct and timely diagnosis. We present the case of a 65-year-old man with a two-year history of colicky biliary pain, who had severe abdominal pain with obstructive symptoms for five days before admission. The diagnosis of gallstone ileus is made using CT scan findings. Enterolithotomy alone was performed three days later. A second, smaller migrated gallstone was also found, which excreted spontaneously. After 20 days, the patient achieved full recovery and was discharged.

An unusual case of cholecysto-enteric fistula with gall stone ileus

“…However, computed tomography (CT) is the preferred imaging method due to its higher sensitivity of 93% 8 . Additionally, gallstone ileus may be identified intraoperatively when a patient is undergoing laparotomy for an unknown cause of small bowel obstruction 9 .…”

“…For gallstones lodged in the small intestine, a twostage procedure is recommended, while a one-stage procedure is preferred for gallstones in other bowel regions 11 . Nonetheless, the patient's overall health and existing medical conditions can influence surgical outcomes and should be carefully considered, particularly for single-stage procedures 5,9 . With a two-stage approach, there's a slight risk of gallstone ileus recurrence, with approximately 10% of patients requiring additional surgical intervention 12 .…”

Small intestinal obstruction due to a giant gallstone: a rare case report from Syria

“…In our case, the patient presented with these classic symptoms, further confirming the typical clinical picture associated with this condition. In terms of radiological findings, abdominal X-rays and computed tomography (CT) scans are commonly utilized to diagnose gallstone ileus by detecting Rigler’s triad (pneumobilia, intestinal obstruction, and visualization of the stone), with CT being the gold standard 4 , 9 , as in this case. Surgical intervention is the mainstay treatment for giant gallstone ileus, with enterolithotomy being the most commonly performed procedure 4 .…”

“…Surgical intervention is the mainstay treatment for giant gallstone ileus, with enterolithotomy being the most commonly performed procedure 4 . However, when gallstones are only up to 2.5 cm in size, they can be discharged spontaneously, and conservative treatment can be recommended 4 , 9 . The GI surgical management is controversial, and four methods are usually performed for treatment: (1) enterotomy with stone extraction alone; (2) bowel resection alone; (3) enterotomy, stone extraction, cholecystectomy, and fistula closure; and (4) bowel resection with fistula closure 4 .…”

Gallstone Ileus in a Woman - A Case Report

“…Rigler's triad, including pneumonia, small bowel obstruction, and ectopic gallstones, represent the pathognomonic findings. Treatment options include surgery (closure of the fistula in one or two stages) or conservative (natural closure of the fistula) [7].…”